Features of the provision of specialized surgical care to those wounded in the stomach in a military medical organization of the 5th level

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Abstract

A prospective analysis of the treatment of patients with abdominal wounds evacuated to the clinic of military field surgery of the Military medical Academy from the area of the Special military operation was carried out. The majority of patients (89.7%) were delivered 2–4 days after the injury. Shrapnel wounds (84.2%) prevailed over bullet wounds (15.8%). The proportion of combined injuries was 98.4%. The vast majority of the wounded (71.6%) at the previous stages of medical evacuation (levels 2–3), surgical intervention in a reduced volume was performed within the framework of the use of Damage Control (DCS) tactics for medical and tactical (61.2%) and vital (10.4%) indications, the tactics of simultaneous surgical treatment (ETC) with complete elimination of damage was implemented much less frequently – in 8.3% of cases, the tactics of Non-Operation Treatment (NOT) tactics – in 13.5% of cases. Operations for undiagnosed abdominal injuries were performed in 14.2% of cases. The mortality rate among the wounded with penetrating abdominal wounds was 8.4%.

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About the authors

A. A. Pichugin

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Author for correspondence.
Email: voenvrach@mail.ru

кандидат медицинских наук, подполковник медицинской службы 

Russian Federation, St. Petersburg

V. I. Badalov

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: voenvrach@mail.ru

заслуженный врач РФ, профессор, полковник медицинской службы

Russian Federation, St. Petersburg

V. Yu. Markevich

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: voenvrach@mail.ru

доцент, полковник медицинской службы

Russian Federation, St. Petersburg

V. V. Suvorov

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: vasily_med@mail.ru

доцент 

Russian Federation, St. Petersburg

A. V. Goncharov

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: voenvrach@mail.ru

доктор медицинских наук, доцент, полковник медицинской службы

Russian Federation, St. Petersburg

K. V. Petukhov

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: voenvrach@mail.ru

кандидат медицинских наук, майор медицинской службы

Russian Federation, St. Petersburg

P. I. Kuraev

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: voenvrach@mail.ru

подполковник медицинской службы

Russian Federation, St. Petersburg

I. M. Samokhvalov

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: voenvrach@mail.ru

заслуженный врач РФ, профессор, полковник медицинской службы в отставке

Russian Federation, St. Petersburg

References

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  2. Методические рекомендации по лечению боевой хирургической травмы / Д.В.Тришкин, Е.В.Крюков, А.П.Чуприна, Б.Н.Котив, И.М.Самохвалов и др. – СПб: ВМедА им. С.М.Кирова, 2022. – 373 с.
  3. Практическое руководство по DAMAGE CONTROL 2.0: Рук-во для врачей / Под ред. И.М.Самохвалова, А.В.Гончарова, В.А.Ревы. – СПб, 2020. – 420 с.
  4. Суворов В.В., Маркевич В.Ю., Гончаров А.В., Пичугин А.А., Мясников Н.И. и др. Дифференцированная хирургическая тактика при травме живота, сопровождающейся повреждением печени и селезенки // Воен.-мед. журн. – 2021. – Т. 342, № 9. – С. 50–57.
  5. Duchesne J., Inaba K., Khan M.A. Damage Control in Trauma Care. – Switzerland: Springer International Publishing AG, 2018. – 281 p.
  6. Feliciano D.V., Mattox K.L., Moore E.E. Trauma. – East Norwalk: Appletion & Lango, 2019. – 458 p.
  7. Hong S.-K., Kim D.K. Primary Management of Polytrauma. – Singapore: Springer Nature Singapore Pte Ltd, 2019. – 184 p.

Supplementary files

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2. Fig. 1. Variants of ready-made defeat elements removed during surgical interventions for penetrating abdominal wounds

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3. Fig. 2. CT cystography result: a) retroperitoneal bladder injury with contrast agent spreading in the paravesical space; b) 3D reconstruction of the bladder defect area.

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4. Fig. 3. CT-irrigraphy results: a) retroperitoneal rectal injury; b) 3D reconstruction of the rectal defect area

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5. Fig. 4. Abdominal CTA result in an abdominal wounded patient with a life support tactic implemented at the previous stage (first stage): a) tampon placed in the subhepatic space; b) laparostomy

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6. Fig. 5. Restoration of intestinal tube continuity (apparatus anastomosis) after obstructive resection of the small intestine performed at the previous stage as part of the KP tactic (first stage).

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7. Fig. 6. Information about the features of the operations performed at the previous evacuation stage, plotted on the patient's abdominal wall: a) "subhepatic abscess", b) "liver tamponade (4 tampons), laparostoma", c) "intestine not opened!!!".

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8. Fig. 7. Technical errors made during the implementation of KP tactics (first stage): a) suturing the skin of the laparotomy wound with excessively sparse sutures; b) ligation of the intestine with thin ligature, which caused wall necrosis

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Copyright (c) 2023 Pichugin A.A., Badalov V.I., Markevich V.Y., Suvorov V.V., Goncharov A.V., Petukhov K.V., Kuraev P.I., Samokhvalov I.M.


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